title: A clinician's perspective on laboratory utilization management.
abstract: BACKGROUND
  Excessive laboratory utilization is a common problem in the hospital setting. Physicians control up to 80% of healthcare costs and wield great influence.
  
  
  METHODS
  This review article describes reasons for overutilization of labs and recommends interventional strategies to change clinician ordering behavior.
  
  
  RESULTS
  Powerful factors exist that encourage overutilization, including fear of missing a diagnosis, provider inexperience, peer pressure, financial rewards, practice inertia, and fear of legal punishment. Features of automated order entry, such as bundling and "daily until discontinued" options contribute to wasteful ordering behavior.
  
  
  CONCLUSIONS
  The most successful and long-lasting interventions are multi-faceted and have included a combination of education, feedback and audit, and administrative changes. The support of senior physicians and top administration is critical to the success of any initiative and ideally, interventions should be original from a multi-disciplinary committee of respected individuals.
authors.affiliation: Clinical Instructor, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge St. #810, Boston, MA 02114, United States. Electronic address: dyeh2@partners.org.
authors.forename: D Dante
authors.initials: DD
authors.lastname: Yeh
mesh_terms: D064790:Clinical Laboratory Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D010820:Physicians
keywords: Clinician perspective; Laboratory test utilization; Utilization interventions; Utilization management